Best states for health care

- Health care score: 43.76
- Cost rank: #26
- Access rank: #51
- Outcomes rank: #47

Georgia will only partially expand Medicaid coverage in July 2021, adding a work requirement and foregoing the federal funds available with full expansions under the Affordable Care Act (ACA). The Kaiser Family Foundation estimates that there are 267,000 Georgia residents that fall into what’s called the Medicaid coverage gap—not eligible for either Medicaid or the subsidies available under the ACA. Work requirements have faced legal challenges.

- Health care score: 43.82
- Cost rank: #37
- Access rank: #18
- Outcomes rank: #49

New Orleans became an early hotspot in the coronavirus pandemic after Mardi Gras in the spring of 2020. As of the beginning of November 2020, there had been 5,951 deaths in the state, according to a New York Times case count.

- Health care score: 43.84
- Cost rank: #30
- Access rank: #46
- Outcomes rank: #48

Alabama has not accepted federal funds available through the Affordable Care Act for Medicaid expansion. If it does expand Medicaid, it would see the largest drop in its uninsured rate among all of the states that have not done so, according to The Robert Wood Johnson Foundation. Its proposed work rules would be the strictest in the country.

- Health care score: 44.32
- Cost rank: #50
- Access rank: #45
- Outcomes rank: #33

About 257,000 people in the state lost health insurance when they lost their jobs during the first six months of the coronavirus pandemic, according to North Carolina Medical Journal.

The pandemic sparked renewed debate over whether the state should expand its Medicaid program, but it did not in 2020. The governor, who favors expansion, estimates that an additional 624,000 residents would be eligible for coverage. North Carolina was one of the last states to adopt Medicaid in January 1970.

- Health care score: 44.36
- Cost rank: #17
- Access rank: #25
- Outcomes rank: #51

Mississippi is one of the 12 states that has not expanded Medicaid, and it has asked for permission from the Centers for Medicare and Medicaid Services. There are 99,000 residents who have no realistic expectation of health insurance with the Medicaid expansion. Nearly three times more residents died from COVID-19 at Mississippi's for-profit nursing homes, according to the Mississippi Center for Investigative Reporting.

- Health care score: 45.61
- Cost rank: #15
- Access rank: #22
- Outcomes rank: #50

Arkansas implemented a work requirement when it expanded its Medicaid program, but it was halted by a federal judge in 2019. In September 2020, it was third in the country for new COVID-19 cases per capita, according to Johns Hopkins University, which has been closely tracking the pandemic.

- Health care score: 46.55
- Cost rank: #35
- Access rank: #34
- Outcomes rank: #45

Tennessee has not expanded Medicaid. It has asked for federal approval for a Medicaid work requirement and a transition to Medicaid block grant funding. There are about 113,000 residents in the so-called Medicaid gap—ineligible both for subsidies and for Medicaid.

- Health care score: 46.57
- Cost rank: #43
- Access rank: #37
- Outcomes rank: #42

South Carolina also has not expanded Medicaid, though it did receive federal approval for a work requirement. If the state did accept Medicaid, it would enable an additional 312,000 people to receive health care coverage.

- Health care score: 46.8
- Cost rank: #34
- Access rank: #48
- Outcomes rank: #38

Texas has not accepted federal Medicaid expansion, leaving 1,685,000 people uninsured who could be getting coverage. Texas gets some of the lowest overall scores in the federal government’s 2018 National Healthcare Quality and Disparities Report, the most recent available.

- Health care score: 46.83
- Cost rank: #51
- Access rank: #30
- Outcomes rank: #20

Alaska did expand its Medicaid program and now covers more than 60,000 additional people, some of whom lost their jobs during the coronavirus pandemic. Alaska also had some of the lowest overall scores in the federal government's 2018 National Healthcare Quality and Disparities Report, which showed a wide discrepancy between Native Alaskans and white residents as far as insurance coverage. Two regions of the state are showing widespread community transmission of COVID-19.

- Health care score: 47.4
- Cost rank: #32
- Access rank: #50
- Outcomes rank: #37

Arizona has one of the lowest overall scores for quality of care, according to the federal government’s 2018 National Healthcare Quality and Disparities Report. Arizona was a coronavirus hotspot in the summer, but brought the virus under control with masks and social distancing. The number of cases in the state fell 75%, the Washington Post reported.

- Health care score: 47.92
- Cost rank: #25
- Access rank: #36
- Outcomes rank: #43

Oklahoma is expanding its Medicaid coverage in 2021 after residents approved the initiative at the polls. As a result, 200,000 people are expected to become eligible. Some lawmakers had pushed to expand the availability of short-term insurance plans, but they were met with criticism. In early September 2020, Oklahoma was fourth in the country for its positivity rate at 11.3%, more than twice the national rate at the time of 5.2%.

- Health care score: 48.18
- Cost rank: #31
- Access rank: #14
- Outcomes rank: #46

The state’s mortality rate from Chronic Obstructive Pulmonary Disease (COPD) is 53% higher than the national rate, a report from West Virginia’s Department of Health and Human Resources Bureau of Public Health notes. The mortality rate from diabetes also is 53%. Both diseases are among a number of health issues the state faces.

- Health care score: 48.38
- Cost rank: #21
- Access rank: #43
- Outcomes rank: #40

Nevada ranks in the top half of the country for high blood pressure, stroke, and diabetes. Top causes of death in the state are heart disease and cancer, according to a report from the University of Nevada in Las Vegas.

- Health care score: 49.01
- Cost rank: #39
- Access rank: #42
- Outcomes rank: #31

During July 2020, five of the country's top 10 COVID-19 hotspots were in Florida, and in October 2020 its positivity rate was rising. Beyond the pandemic, Floridians are worried about food insecurity, access to health care, and access to mental health care, according to a 2019 health assessment study conducted by various health centers in the state.

- Health care score: 49.93
- Cost rank: #48
- Access rank: #41
- Outcomes rank: #17

The country’s first coronavirus outbreak occurred in a Washington state nursing home in the spring of 2020, which has now been tied to COVID-19 deaths. The state expanded its Medicaid under the Affordable Care Act early on, reducing the number of people without insurance, but that progress has been dented by the coronavirus pandemic. The uninsured rate is 12% in 2020.

- Health care score: 50.2
- Cost rank: #33
- Access rank: #15
- Outcomes rank: #41

Missouri will expand its Medicaid program in 2021 after voters approved the change. An additional 230,000 people will be able to enroll in health care. Among the state's past failures were access to dental care for adults, preventable hospitalizations, and deaths in hospitals.

- Health care score: 50.52
- Cost rank: #42
- Access rank: #35
- Outcomes rank: #26

California legislators want to lower prescription drug costs and to make health care more available to residents. They also would tax vaping. California imposed early shutdowns to try to combat the coronavirus, which spread across the state. It had more than 950,000 cases by early November 2020. It escaped a surge in cases in the fall while reopening businesses, but then saw cases begin to rise in some Southern California counties.

- Health care score: 50.99
- Cost rank: #41
- Access rank: #47
- Outcomes rank: #16

In Idaho, 53,000 people gained health care after it expanded its Medicaid program in January 2020. Among the health care issues it faces: 30% of adults in Idaho are obese, and 22.5% are mentally ill, one of the highest rates in the country.

- Health care score: 51.32
- Cost rank: #49
- Access rank: #28
- Outcomes rank: #14

Oregon saw 557,000 people enroll in Medicaid after it was expanded. The state's health care problems include obesity, alcohol and substance abuse, tobacco use, and immunization rates. Obesity, for example, is a top cause of preventable death in the state.

- Health care score: 51.66
- Cost rank: #46
- Access rank: #38
- Outcomes rank: #18

Wyoming is among the U.S. states that have not expanded Medicaid, with 6,000 people unlikely to gain health insurance without it. The number of coronavirus cases was on the rise in October 2020, but intensive care beds were available.

- Health care score: 51.7
- Cost rank: #16
- Access rank: #31
- Outcomes rank: #39

The RAND Corporation reported at the beginning of 2020 that Indiana’s hospital prices were the highest compared to 24 other states, and twice as high as neighboring Michigan. Republican lawmakers have been looking at ways to curb the costs. Since September 2020, Indiana has had a 200% increase in the number of new daily COVID-19 cases, with a positivity rate of 8.7%

- Health care score: 51.84
- Cost rank: #12
- Access rank: #40
- Outcomes rank: #36

Chronic diseases are a problem for New Mexico, where heart disease, stroke, cancer, diabetes, and emphysema are leading causes of death, and arthritis is a leading cause of disability, according to a 2018 assessment of the state’s health. Rates vary by race and ethnicity.

- Health care score: 52.58
- Cost rank: #27
- Access rank: #24
- Outcomes rank: #32

Nearly 1.7 million New York City residents were infected with the coronavirus or about 20% of the population. New York City saw a surge of cases in the spring of 2020 that killed 20,000 people. Hospitalizations are again up late in 2020, but far fewer deaths are being reported and masks and social distancing are helping to limit the virus’ spread.

- Health care score: 52.62
- Cost rank: #9
- Access rank: #6
- Outcomes rank: #44

Three out of four people in Kentucky are worried about being able to afford health care, in particular care for COVID-19, according to a 2020 survey. Unhappiness with the health care system was bipartisan and widespread. Those responding said they wanted their choices for health care expanded.

- Health care score: 53.73
- Cost rank: #45
- Access rank: #11
- Outcomes rank: #21

Expanded enrollment in Medicaid began going to effect in October 2020 and 123,000 people are expected to be able to take advantage of the program. A study from the University of Nebraska Medical Center in 2018 found that 13 of its 93 counties had no primary care physicians, but that the number of physicians and registered nurses in the state had increased.

- Health care score: 54.27
- Cost rank: #22
- Access rank: #21
- Outcomes rank: #27

A 2018 report on the state of Illinois’ rural health care found shortages of primary care doctors and psychiatrists, and deaths from opioid abuse. For young people in Chicago, top health problems included stress, drug abuse, and depression, according to a different study. Three dozen health care organizations in Chicago are working together to counter health disparities.

- Health care score: 54.35
- Cost rank: #8
- Access rank: #29
- Outcomes rank: #34

Ohio did accept federal funds to expand Medicaid and has been able to cover 526,100 people. The number of cases of COVID-19 and hospitalizations were soaring in October 2020, and the number of people enrolling in Medicaid rose by more than 250,000 during the pandemic.

- Health care score: 55.04
- Cost rank: #19
- Access rank: #27
- Outcomes rank: #24

New Jersey was experiencing a second wave of COVID-19 in November 2020, with hospitalizations at 1,213 people. Test positivity was 8.22%, the highest since May 2020. The Commonwealth Fund’s 2019 ranking found low rates for smoking, alcohol use, and suicide, but drug overdoes remained a problem.

- Health care score: 55.24
- Cost rank: #5
- Access rank: #33
- Outcomes rank: #30

Michigan residents have excellent access to health care, but the state struggles with smoking rates and deaths from drugs and heart disease that are higher than the national average. Union jobs there helped to provide better hospitals and insurance.

- Health care score: 55.26
- Cost rank: #28
- Access rank: #20
- Outcomes rank: #19

Enrollment in Medicaid has grown by 25,000 since the state expanded its program under the Affordable Care Act. State officials remain worried about COVID-19 outbreaks in long-term care facilities, where more than 50% of deaths have occured.

- Health care score: 55.53
- Cost rank: #18
- Access rank: #49
- Outcomes rank: #10

Three quarters of those responding to a 2019 survey on health care in Virginia reported being worried about future costs. Just over half of the 1,100 respondents said they had experienced problems with cost in the past year. The number of COVID-19 cases in Virginia is increasing in November 2020, slowing down some of the region's reopenings.

- Health care score: 55.72
- Cost rank: #24
- Access rank: #44
- Outcomes rank: #8

Utah expanded Medicaid in January 2020, which could bring 70,000 to 90,000 people into the program. More than half of Utahns said they had difficulty affording health care, according to a study released at the same time. More people were buying high deductible plans through their employers.

- Health care score: 56.42
- Cost rank: #44
- Access rank: #8
- Outcomes rank: #11

Wisconsin has rejected expansion of Medicaid with federal funds, but it has used its own money to do it instead. Still, a Robert Wood Johnson Foundation analysis found that another 120,000 people could gain coverage if the state accepted the federal money. Wisconsin expects to face a shortage of rural primary doctors by 2035 and many counties already do not have psychiatrists.

- Health care score: 56.61
- Cost rank: #14
- Access rank: #9
- Outcomes rank: #29

Gov. Tom Wolf announced in October 2020 that the state would reform its health care system to reduce inequities, implement savings, and address social causes of poor health. On Nov. 3, 2020, the state saw the largest one-day increase in COVID-19 cases. Pennsylvania hospitals lost an estimated $10 billion in 2020 because of the coronavirus pandemic.

- Health care score: 56.78
- Cost rank: #3
- Access rank: #32
- Outcomes rank: #25

Maryland is trying to keep health care costs down by setting prices hospitals can charge and by capping each hospital’s revenue, Vox reports. The number of cases of COVID-19 in Maryland is increasing in November 2020, forcing the region to slow some reopenings.

- Health care score: 57.14
- Cost rank: #10
- Access rank: #12
- Outcomes rank: #28

Kansas has not accepted federal funds to expand Medicaid, which would make 150,000 more people eligible to enroll. Top killers in Kansas include heart disease, cancer, chronic lower respiratory disease, accidents, and strokes, according to the Centers for Disease Control and Prevention. Among adults, 31.25% are obese.

- Health care score: 57.37
- Cost rank: #47
- Access rank: #2
- Outcomes rank: #12

As of the summer of 2020, more than 57,000 people had enrolled in Maine’s expanded Medicaid program. The University of Maine reports that among the top health issues for Maine’s residents are access to health care, chronic disease, exposure to hazards in the environment, and infectious disease. The day after the country’s Nov. 3, 2020 presidential election, Maine set a record for the number of single-day coronavirus cases with 151.

- Health care score: 57.41
- Cost rank: #40
- Access rank: #23
- Outcomes rank: #3

New Hampshire is one of the highest spending states for health care because much of it is hospital-based, according to a Health Care Cost Institute study. It was fourth in the country for access and for outcomes in another study, but residents were paying, on average, $145 for a medical visit.

- Health care score: 57.59
- Cost rank: #2
- Access rank: #26
- Outcomes rank: #23

Montana was experiencing a shortage of health care workers as a result of a spike in COVID-19 cases in October 2020. The problem was particularly acute on Native American reservations. Montana was seeking help from the National Guard and other states.

- Health care score: 57.69
- Cost rank: #38
- Access rank: #17
- Outcomes rank: #4

The care that Connecticut residents receive in its hospitals can be described as average quality, but the cost is very high, according to a Connecticut Health Policy Project report. High drug prices are one reason for the costs. As of November 2020, the coronavirus hospitalizations were rising.

- Health care score: 57.81
- Cost rank: #23
- Access rank: #16
- Outcomes rank: #13

South Dakota has not accepted federal funds to expand its Medicaid program, leaving behind 43,000 people who could be enrolled. The state infamously permitted the Sturgis Motorcycle Rally to be held in August 2020, a gathering that led to significant spread of the COVID-19, according to a study from San Diego State University.

- Health care score: 58.59
- Cost rank: #13
- Access rank: #39
- Outcomes rank: #6

Vaping, excessive drinking, and diabetes are worsening in Hawaii. The state’s health director warned in November that Hawaii was in a health care crisis. It will spend $14 million to bring in more than 200 nurses and other specialists to help with the coronavirus pandemic.

- Health care score: 58.7
- Cost rank: #11
- Access rank: #19
- Outcomes rank: #15

During the 2020 presidential campaign, health care was the top issue for Iowa, and residents are worried about how to keep rural hospitals open and health care costs down. Iowa’s rate of new COVID-19 cases was the sixth highest in the country at the beginning of November 2020.

- Health care score: 59.06
- Cost rank: #36
- Access rank: #13
- Outcomes rank: #2

Colorado was seeing a surge in COVID-19 cases at the beginning of November 2020 and hospitals were trying to avoid being overwhelmed. They were rescheduling surgeries and taking other measures. A survey in 2019 found that an increasing number of residents were worrying about the affordability of health care.

- Health care score: 59.49
- Cost rank: #29
- Access rank: #10
- Outcomes rank: #5

Based on a January 2020 report to Vermont’s legislature, the state is one of the most rural in the country and is aging quickly. Just over 40% of Vermonters are covered by Medicare and Medicaid. Residents in the very rural areas are the oldest and are in the poorest of health. Chronic disease is the most common cause of death in Vermont, and the cost for care is estimated to be $3 billion in 2020.

- Health care score: 60.7
- Cost rank: #7
- Access rank: #3
- Outcomes rank: #22

Like other rural states, North Dakota struggles to find and keep primary care physicians and other health professionals. The state saw a surge of COVID-19 cases in the fall of 2020, and at one point was first in the country in the number of new cases per capita.

- Health care score: 60.72
- Cost rank: #1
- Access rank: #1
- Outcomes rank: #35

A community health needs assessment in 2019 found that the District of Columbia needed mental health services, coordination of care, health literacy, and place-based care that is convenient and culturally sensitive. As in Maryland and Virginia, the number of cases of COVID-19 in the District of Columbia, increased in November 2020, forcing the region to postpone some reopenings.

- Health care score: 62.22
- Cost rank: #6
- Access rank: #7
- Outcomes rank: #7

Diabetes and high blood pressure are common and expensive chronic conditions in Rhode Island, according to its Department of Health. Depression is a third. In 2019, the Commonwealth Fund’s scorecard on the performance of state health systems found Rhode Island’s was the most improved.

- Health care score: 63.11
- Cost rank: #4
- Access rank: #5
- Outcomes rank: #9

On Nov. 4, 2020, a day after the U.S. presidential election, Minnesota broke its coronavirus records with the number of COVID-19 cases reported and the number of hospitalizations. Gov. Tim Walz said he was asking for federal help for the hospitals and for long-term care facilities.

- Health care score: 63.47
- Cost rank: #20
- Access rank: #4
- Outcomes rank: #1

Massachusetts saw a spike of COVID-19 cases in the spring of 2020, a drop over the summer, and a steady rise in the fall. In data released at the end of October 2020, it was evident that the majority of coronavirus clusters came from households.